Jiang Li-ping, Wang Guo-min, Yang Yu-sheng, Chen Yang, Wu Yi-lai
Department of Oral and Maxillofacial Surgery, Cleft Lip and Plate Center, Ninth People's Hospital, School of Stomatology Shanghai Second Medical University, Shanghai 200011, China.
Shanghai Kou Qiang Yi Xue. 2004 Oct;13(5):444-6.
Speech therapy was carried out for patients with speech disorders after pharyngoplasty, and the comparison of speech articulation before and after treatment, was done to evaluate the new method.
82 patients with the varying age from 4 to 31 years were included in the current study. The patients' speeches including syllables, word, phrase and sentence were compared before and after treatment according to Chinese Speech Intelligibility Testing Form. The systematic speech training was carried out according to the compensatory articulation characteristics. The steps were as follows. Firstly, the function of velopharyngeal closure should be strengthened. Secondly, the patients were trained with an average duration of 3.83 months (range from 1.5-12 months) according to the following three sequences: One was from phoneme, syllables, phrase, sentence to short paragraph or dialogue, another was from anterior to posterior according to the speech position, and the other was from easy to difficult according to the articulation method, such as from aspirated syllables to non-aspirated syllables, from plosive, fricative to affricative.
There were 71 patients with compensatory articulation characteristic of velopharyngeal incompetence, the speech articulation of patients with glottis plosive increased from preoperative 46.27% to postoperative 97.16% (P<0.001). The speech articulation of patients with pharynx fricative increased from preoperative 57.19% to postoperative 97.72% (P<0.001). There were 11 patients with compensatory articulation characteristic of velopharyngeal adequacy, and the speech articulation of 11 patients with palatalized and lateral misarticulation increased from preoperative 71.10% to postoperative 98.55% (P<0.001).
The training of velopharyngeal closure should be emphasized on the patients with compensatory articulation resulting from velopharyngeal incompetence after pharyngoplasty, then the correct speech position and method was established. While to the patients with compensatory articulation without velopharyngeal incompetence after pharyngoplasty, the correct speech position and method could be directly established.
对咽成形术后出现言语障碍的患者进行言语治疗，通过比较治疗前后的言语清晰度来评估新方法。
本研究纳入82例年龄在4至31岁之间的患者。根据汉语言语清晰度测试表，比较患者治疗前后包括音节、单词、短语和句子在内的言语情况。根据代偿性构音特点进行系统的言语训练。步骤如下。首先，应加强腭咽闭合功能。其次，按照以下三个顺序对患者进行平均时长为3.83个月（范围为1.5至12个月）的训练：一是从音素、音节、短语、句子到短文或对话；二是根据言语位置从前向后；三是根据构音方法从易到难，如从送气音节到不送气音节，从塞音、擦音到塞擦音。
有71例患者具有腭咽闭合不全的代偿性构音特点，声门爆破音患者的言语清晰度从术前的46.27%提高到术后的97.16%（P<0.001）。咽擦音患者的言语清晰度从术前的57.19%提高到术后的97.72%（P<0.001）。有11例患者具有腭咽功能正常的代偿性构音特点，11例腭化和侧化构音错误患者的言语清晰度从术前的71.10%提高到术后的98.55%（P<0.001）。
对于咽成形术后因腭咽闭合不全导致代偿性构音的患者，应强调腭咽闭合训练，然后建立正确的言语位置和方法。而对于咽成形术后无腭咽闭合不全的代偿性构音患者，可直接建立正确的言语位置和方法。
